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  • Writer's pictureTom Petersen

Respiratory Protection in Healthcare

Updated: Aug 29, 2023

H1N1 Virus Exposure Control

Ever since the H1N1 outbreak in the spring of 2009, much attention has focused on how to best protect healthcare workers from the virus that is transmitted by:

  • Droplet exposure of mucosal surfaces (e.g. nose, mouth and eyes)

  • Contact with hands or surfaces contaminated with secretions and exposure to mucosal areas

  • Small particle aerosols in close proximity to the infected individual

Personal Protective Equipment is the last line of defense in the hierarchy of controls after: (1) Elimination, (2) Engineering Controls and (3) Administrative Controls. Hospitals throughout the world have taken steps to restrict outpatients and visitors with suspected or confirmed flu symptoms. They have implemented engineering controls like partitions in triage areas. They have increased employee vaccination rates. Hospitals have improved employee hand hygiene compliance. Some hospitals even offer employee bonuses for reaching hand hygiene milestones (e.g. 80% compliance rate).

NIOSH and the CDC recommend an N-95 respirator or better for workers that come into contact patients having the H1N1 virus. This includes healthcare personnel, employees, contractors, volunteers, students, and clergy. Most hospitals have struggled to fully comply with the standards. That is because respirators are a form of personal protective equipment that is dependent on the employee having a recognition of hazards, selecting the correct type of PPE, using and maintaining it and being fit-tested for proper size, wear-ability and use.

Respiratory Protection

14 million people (approximately 10% of the U.S. workforce) are employed in the healthcare industry. Employee protection against infectious disease may include gloves, eye protection, face shield, gowns and/or respirators. The N-95 style respirator is the most common respirator used. Appropriate use of respirators is fundamental to employee protection.

Employees need to know the difference between medical masks and respirators. Medical masks are loose fitting, cover the nose and mouth and are designed to protect patients from the coughs or secretions of healthcare workers. Medical masks are not considered personal protective equipment.

The N-95 and N-100 respirators are tight fitting. OSHA requires that all users be trained, fit-tested and be retested annually. Employees need to have a basic medical evaluation, know the size of the respirator that fits, and know how to get a good face seal.

Respiratory Protection Plan

The respiratory protection plan must address questions about the reusability of PPE, how long viruses survive on surfaces and what provides a protective barrier against viruses. Additional questions in the plan include:

  • What are the major modes of transmission?

  • What size are the aerosols?

  • What is the infectivity?

  • Is humidity an issue?

  • Does air exchange and ventilation affect transmission?

Onsite Fit Testing

Many organizations struggle to be fully compliant with fit testing portions of the Respiratory Protection Standard. Some organizations use vendors to assist with their annual requirements. Employees are to pass medical clearance prior to the testing. They are to use their own mask or an identical mask during the test. Each test takes about 10-15 minutes and multiple tests may occur simultaneously. Employees are taught how and when to use the respirator, how to position it, how to set strap tension and how to get a good fit. The test cannot be conducted if the employee has facial hair growth. Should an employee have difficulty breathing during the test, he or she is referred to a licensed professional to determine if the employee can safely wear a respirator. A record of the test must to be kept on file in the workplace. The record must contain the employee’s name, the fit factor, make, model, style, size of respirator used and the date tested.

What has been your organization’s experience with respiratory protection? Would you care to share any tips or strategies? Comments on this blog are always welcome and encouraged.

Call us for further information about our services in respiratory protection compliance in healthcare or other settings.



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